Weathering the Storms: Winning Strategies for Managing Incident Stress
by Marilyn Neudeck-Dicken, Ph.D.

 

I was greatly moved by the information shared by members of ASCR throughout the conference last September. In the wake of Katrina, Rita and Wilma, stress management has become vital to the functioning of employees doing cleanup and restoration after these hurricanes. Disaster, death and violence are incidents that are directly linked to Posttraumatic Stress Disorder. The reduction of long-term effects and hidden emotional damage caused by such incidents should be an issue addressed by all companies involved in trauma response. It is easy to say that our employees will "get over it" in time, but all of us are prone to Posttraumatic Stress Disorder if the circumstances are right. Psychological distress can be hidden, leaving us exposed to cumulative stress reactions. If the stress continues to build up, our bodies develop stress-related symptoms and physical illness results.

We normally deny, ignore or minimize all kinds of stress: however, disasters, acts of terrorism, death of colleagues and death of children all disrupt our basic belief that we are safe and secure. We want to believe that we can face any situation and that we have all the tools we need for coping. Therefore, it is easier to deny stress than to admit that our tools do not fit the situation or our needs. When we are suddenly confronted by a traumatic and shattering experience, our safe and secure world can collapse, resulting
in: fear and confusion, the loss of our belief systems, self-worth and value as human beings.

If our equilibrium is not restored, depression, a sense of pointlessness and even suicide can result. If our response to stress continues to build up over time, we develop cumulative stress reactions, resulting in stress-related symptoms and illnesses. Untreated stress can cause a slowing of the immune system. Organs give way to progressive destruction. The results are manifested in a range of disorders and diseases ranging from heart attacks to cancer.

We live with general stressors and stress symptoms from the moment we wake until we go to bed. Stress is brought on by the events and demands in our lives and our actions and reactions to these events. Stress has its inception both outside of us -in the work we do- and within us-our response to work. The management of stress involves working with our selves and these events and demands. The focus of incident stress management is to change our thinking and reactions to stressful events so that stress can work for us in a positive way.

Understanding the stress response can help employers recognize when an employee is in trouble. I have encountered four stages to incident stress.

Stage of Anticipation comes right after we are notified of the incident. Anticipatory stress deals with the unknown. We have no idea of what we are facing and no idea of what to expect. In this stage, we doubt ourselves and our ability to be able to do the job.

The media plays an important part in this stage and can often terrify our psyche into believing we are incompetent because the incident is "too overwhelming". We forget that the media plays up the worst events, leaving us to believe that the critical incident is earth shattering.

Stage of Reality Shock develops when we arrive at the site. Often we are overwhelmed by the task at hand. This stage brings anxiety, a sense of shock, a feeling that we cannot do enough to help. Also, this stage can lead to the need to work feverishly. A fireman who worked after 9/11 told me he was driven to dig with his hands, since he did not have a shovel. It was only after he saw that his hands were bleeding that he realized what he was doing. This stage defines the abnormal event in terms of mental traumatization.

Stage of Desperation/Stage of Acute Reactions develops after the job is completed. It is normal to push physical and psychological stress out of the way until the job is done. After we complete a difficult task, withdrawing, feeling abandoned or "different", and having thoughts that no one understands are all normal perceptions of an abnormal situation. Feelings of depression, anguish, remorse and sadness can result. Talking about the incident becomes difficult, and we become introspective. We start questioning our belief systems, our lives, our faith and who we are. We feel guilty because we did not do enough. We become vulnerable, and our world as we knew it has collapsed. These post-traumatic stress reactions are normal responses to abnormal events.

However, in this stage we can lose a purpose for living, and this sense of pointlessness can lead to suicide. It is also this stage that can lead to affect disintegration: chronic illness emerges, psychotic episodes develop, loss of trust shatters meaningful attachments, chronic guilt and self-blame becomes intrusive. Relative, friends and colleagues do not want to hear about the incident and we feel that they no longer are giving support. As a result, loneliness and isolation can develop. What can emerge is Posttraumatic Stress Disorder (PTSD). The degree of stress experienced is proportional to these five factors:


1. The amount of empathy one possesses
2. Past traumatic events one has experienced
3. Unresolved traumatic conflicts one may harbor
4. The amount of exposure to family, children's or friends' trauma
5. The degree of maladaptive responses one uses as a survival strategy

Number two addresses cumulative stress. Cumulative stress compounded by a catastrophe can cause emotional and physical breakdown. Cumulative stress is subtle and often ignored, denied and minimized because the stress starts to feel normal. Unfortunately, major life changes develop. Marital problems rank first as the inducing factor to a cumulative stress response. It is often easier to blame an event than to make life changes. If our response to stress continues to build up, our bodies develop stress-related symptoms and illness results.

Stage of Reconciliation/Stage of Acute Posttraumatic Stress is when we live through and learn from our stress. The underlying attitude an individual brings to a stressful situation largely determines whether the stress will be used for growth or be debilitating. In this stage we can grow from the traumatic event and incorporate it into our psyche, or we can develop acute Posttraumatic Stress Symptoms. Distress during the days that follow the incident resemble those of PTSD; however, it is difficult to differentiate between normal responses to an abnormal incident and responses that develop into PTSD.

Terrorism is a new form of incident stress that demands more than adaptation and coping. The stress of terrorism necessitates a confrontation with the threat of helplessness, death and mutilation. Another element to the entity of trauma is the way the incident and past incidents become a way to haunt the individual's functioning in the present. The results are fear and uncertainty because the sequential stressors have a cumulative effect. Oklahoma City, Columbine and September 11 represent an assault on our sense of personal safety and belief in humanity. This shattering of beliefs can traumatize the individuals in the restoration field to a greater degree than what is experienced by a primary victim because it is cumulative, group related, ongoing, affects the functioning of a group, and is often viewed as individual pathology and not as an "event that happened to the United States of America". There is a cost to caring and the price can be individual, as well as large group disintegration.

In short, it is easy for every one of us to set ourselves up for stress reactions. Without normalizing the situation, we have no idea that the symptoms we exhibit are symptoms the normal population would express. We cannot always change the events and demands in our daily lives, but we can change our way of looking at those events and our reaction to stressful demands.

In my book, Cumulative Stress Management for Search and Rescue: A Workbook for all Emergency Personnel, the premise is simple: We all need to practice ways in which we can define ourselves by our typical moments and not our worst moments. This key to surviving incident stress is paramount to our functioning because it puts us in control. The acceptance and insight into who we are and how we respond to stress are keys to our mental health. In other words, learning to grow from stress reactions, finding ways to deal with uncertainty, meditation and relaxation, coming to terms with death, taking care of our bodies physically, and helping our loved ones cope with the stress are all critical "defusers" to stress management for emergency workers. Since I believe that every one of us needs to take responsibility for our ongoing health, having tools to reduce our stress is the key to prevention.

So, what is the answer? Studies have shown that training for stressful events protects individuals from the effects of stress. Ongoing training can reduce uncertainty, increase one's sense of control, and teach automatic responses. Training is effective in generating positive response outcome. * Reading positive affirmations concerning one's abilities enroute to the incident can also have the same effect in reducing uncertainty. **

The urgency to prepare our personnel for future man-made disasters and acts of terrorism so that psychological effects will be minimal is paramount. We need to reexamine our procedures so that our employees are protected from environmental harm during and after their work. Since interventions concerning man-made disasters are different from natural disasters, we need to focus on this new frontier: terrorism and human-constructed disasters. Oklahoma City and September 11 were America's largest man-made horror shows. The very thought that we could become a battleground to terrorism devastates the normal American concept of good will. Let us use what we have learned from these events and develop positive scenarios for the future. Hopefully time and and preparation will increase our knowledge and lessen the impacts of future disasters.

Marilyn Neudeck-Dicken, Ph.D. is a pioneer in the area of traumatic stress and has decades of experience based on extensive research and firsthand knowledge. She has been involved in incidents such as the Oklahoma City bombing, four Mobil explosions, the Columbine shootings, and the Cerritos and San Diego plane crashes. She can be reached at drmend2@yahoo.com.

References:
*Chemtob et al.1990; Hytten 1989'
**Neudeck-Dicken, 1997